STU 3 Candidate

This page is part of the FHIR Specification (v1.4.0: STU 3 Ballot 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

4.36 Resource ImagingExcerpt - Content

Imaging Integration Work GroupMaturity Level: 0Compartments: Patient

A manifest of a set of DICOM Service-Object Pair Instances (SOP Instances). The referenced SOP Instances (images or other content) are for a single patient, and may be from one or more studies. The referenced SOP Instances have been selected for a purpose, such as quality assurance, conference, or consult. Reflecting that range of purposes, typical ImagingExcerpt resources may include all SOP Instances in a study (perhaps for sharing through a Health Information Exchange); key images from multiple studies (for reference by a referring or treating physician); a multi-frame ultrasound instance ("cine" video clip) and a set of measurements taken from that instance (for inclusion in a teaching file); and so on.

4.36.1 Scope and Usage

This resource groups a set of imaging objects for some specified purpose, and provides references to where the images are available using either DICOM or ready to view formats. This resource is used to make available information concerning images etc. that are intended to be exchanged into other clinical contexts such as diagnostic reports, Care Plans, etc.

4.36.2 Boundaries and Relationships

In distinction to ImagingStudy, this resource is a set of specifically selected objects, potentially from multiple studies on the same patient. ImagingStudy is intended as the resource that identifies a single complete study in itself.

4.36.3 Background and Context

This resource corresponds to the DICOM Key Object Selection (KOS) SOP Class, and may represent a FHIR access mechanism to the content of KOS SOP Instances. The content is closely based on the definitions of the equivalent DICOM constructs, and informed by usage patterns already established through DICOM implementation practices, including IHE KIN, TCE, and XDS-I profiles. However, it is not necessary to use DICOM infrastructure in order to use this resource.

The DICOM access methods provide access using the rich controls of the DICOM access methodology indicated. A DICOM client may use these access methods to gain full access to the DICOM objects and header.

The viewable access method provides access to a web rendered forms that can be directly pulled and displayed without knowing DICOM web protocols. The viewable access method might provide thumnail formats, various perspectives, and various rendered formats.

4.36.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingExcerpt DomainResourceKey Object Selection
... uid Σ1..1oidInstance UID
... patient Σ1..1Reference(Patient)Patient of the selected objects
... authoringTime Σ0..1dateTimeTime when the imaging object selection was created
... author Σ0..1Reference(Practitioner | Device | Organization | Patient | RelatedPerson)Author (human or machine)
... title Σ1..1CodeableConceptReason for selection
KOStitle (Required)
... description Σ0..1stringDescription text
... study Σ1..*BackboneElementStudy identity of the selected instances
.... uid Σ1..1oidStudy instance UID
.... imagingStudy Σ0..1Reference(ImagingStudy)Reference to ImagingStudy
.... dicom 0..*BackboneElementDicom web access
..... type 1..1codeWADO-RS | WADO-URI | IID | WADO-WS
dWebType (Required)
..... url 1..1uriRetrieve study URL
.... viewable 0..*BackboneElementViewable format
..... contentType 1..1codeMime type of the content, with charset etc.
MimeType (Required)
..... height 0..1positiveIntHeight of the image in pixels (photo/video)
..... width 0..1positiveIntWidth of the image in pixels (photo/video)
..... frames 0..1positiveIntNumber of frames if > 1 (photo)
..... duration 0..1unsignedIntLength in seconds (audio / video)
..... size 0..1unsignedIntNumber of bytes of content (if url provided)
..... title 0..1stringLabel to display in place of the data
..... url 1..1uriUri where the data can be found
.... series Σ1..*BackboneElementSeries identity of the selected instances
..... uid Σ1..1oidSeries instance UID
..... dicom 0..*BackboneElementDicom web access
...... type 1..1codeWADO-RS | WADO-URI | IID | WADO-WS
dWebType (Required)
...... url 1..1uriRetrieve study URL
..... instance Σ1..*BackboneElementThe selected instance
...... sopClass Σ1..1oidSOP class UID of instance
...... uid Σ1..1oidSelected instance UID
...... dicom 0..*BackboneElementDicom web access
....... type 1..1codeWADO-RS | WADO-URI | IID | WADO-WS
dWebType (Required)
....... url 1..1uriRetrieve study URL
...... frameNumbers 0..*unsignedIntFrame reference number

doco Documentation for this format

UML Diagram

ImagingExcerpt (DomainResource)Unique identifier of the DICOM Key Object Selection (KOS) representationuid : oid [1..1]A patient resource reference which is the patient subject of all DICOM SOP Instances in this ImagingExcerptpatient : Reference [1..1] « Patient »Date and time when the selection of the referenced instances were made. It is (typically) different from the creation date of the selection resource, and from dates associated with the referenced instances (e.g. capture time of the referenced image)authoringTime : dateTime [0..1]Author of ImagingExcerpt. It can be a human author or a device which made the decision of the SOP instances selected. For example, a radiologist selected a set of imaging SOP instances to attach in a diagnostic report, and a CAD application may author a selection to describe SOP instances it used to generate a detection conclusionauthor : Reference [0..1] « Practitioner|Device|Organization|Patient| RelatedPerson »The reason for, or significance of, the selection of objects referenced in the resourcetitle : CodeableConcept [1..1] « The document title code of key object selection (Strength=Required)KOStitle! »Text description of the DICOM SOP instances selected in the ImagingExcerpt. This should be aligned with the content of the title element, and can provide further explanation of the SOP instances in the selectiondescription : string [0..1]StudyStudy instance UID of the SOP instances in the selectionuid : oid [1..1]Reference to the Imaging Study in FHIR formimagingStudy : Reference [0..1] « ImagingStudy »DicomAccess type for DICOM webtype : code [1..1] « The type of DICOM web technology available (Strength=Required)dWebType! »The source system root URL / base URL, from which all content can be retrieved using the specified DICOM protocolurl : uri [1..1]ViewableIdentifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriatecontentType : code [1..1] « The mime type of an attachment. Any valid mime type is allowed. (Strength=Required)MimeType! »Height of the image in pixels (photo/video)height : positiveInt [0..1]Width of the image in pixels (photo/video)width : positiveInt [0..1]The number of frames in a photo. This is used with a multi-page fax, or an imaging acquisition context that takes multiple slices in a single image, or an animated gifframes : positiveInt [0..1]The duration of the recording in seconds - for audio and videoduration : unsignedInt [0..1]The number of bytes of data that make up this attachmentsize : unsignedInt [0..1]A label or set of text to display in place of the datatitle : string [0..1]A location where the data can be accessedurl : uri [1..1]SeriesSeries instance UID of the SOP instances in the selectionuid : oid [1..1]DicomAccess type for DICOM webtype : code [1..1] « The type of DICOM web technology available (Strength=Required)dWebType! »The source system root URL / base URL, from which all content can be retrieved using the specified DICOM protocolurl : uri [1..1]InstanceSOP class UID of the selected instancesopClass : oid [1..1]SOP Instance UID of the selected instanceuid : oid [1..1]The specific frame reference within a multi-frame objectframeNumbers : unsignedInt [0..*]DicomAccess type for DICOM webtype : code [1..1] « The type of DICOM web technology available (Strength=Required)dWebType! »The source system root URL / base URL, from which all content can be retrieved using the specified DICOM protocolurl : uri [1..1]Methods of accessing using DICOM web technologiesdicom[0..*]A set of viewable reference images of various typesviewable[0..*]Methods of accessing using DICOM web technologiesdicom[0..*]Methods of accessing using DICOM web technologiesdicom[0..*]Identity and locating information of the selected DICOM SOP instancesinstance[1..*]Series identity and locating information of the DICOM SOP instances in the selectionseries[1..*]Study identity and locating information of the DICOM SOP instances in the selectionstudy[1..*]

XML Template

<ImagingExcerpt xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <uid value="[oid]"/><!-- 1..1 Instance UID -->
 <patient><!-- 1..1 Reference(Patient) Patient of the selected objects --></patient>
 <authoringTime value="[dateTime]"/><!-- 0..1 Time when the imaging object selection was created -->
 <author><!-- 0..1 Reference(Practitioner|Device|Organization|Patient|
   RelatedPerson) Author (human or machine) --></author>
 <title><!-- 1..1 CodeableConcept Reason for selection --></title>
 <description value="[string]"/><!-- 0..1 Description text -->
 <study>  <!-- 1..* Study identity of the selected instances -->
  <uid value="[oid]"/><!-- 1..1 Study instance UID -->
  <imagingStudy><!-- 0..1 Reference(ImagingStudy) Reference to ImagingStudy --></imagingStudy>
  <dicom>  <!-- 0..* Dicom web access -->
   <type value="[code]"/><!-- 1..1 WADO-RS | WADO-URI | IID | WADO-WS -->
   <url value="[uri]"/><!-- 1..1 Retrieve study URL -->
  </dicom>
  <viewable>  <!-- 0..* Viewable format -->
   <contentType value="[code]"/><!-- 1..1 Mime type of the content, with charset etc.  -->
   <height value="[positiveInt]"/><!-- 0..1 Height of the image in pixels (photo/video) -->
   <width value="[positiveInt]"/><!-- 0..1 Width of the image in pixels (photo/video) -->
   <frames value="[positiveInt]"/><!-- 0..1 Number of frames if > 1 (photo) -->
   <duration value="[unsignedInt]"/><!-- 0..1 Length in seconds (audio / video) -->
   <size value="[unsignedInt]"/><!-- 0..1 Number of bytes of content (if url provided) -->
   <title value="[string]"/><!-- 0..1 Label to display in place of the data -->
   <url value="[uri]"/><!-- 1..1 Uri where the data can be found -->
  </viewable>
  <series>  <!-- 1..* Series identity of the selected instances -->
   <uid value="[oid]"/><!-- 1..1 Series instance UID -->
   <dicom>  <!-- 0..* Dicom web access -->
    <type value="[code]"/><!-- 1..1 WADO-RS | WADO-URI | IID | WADO-WS -->
    <url value="[uri]"/><!-- 1..1 Retrieve study URL -->
   </dicom>
   <instance>  <!-- 1..* The selected instance -->
    <sopClass value="[oid]"/><!-- 1..1 SOP class UID of instance -->
    <uid value="[oid]"/><!-- 1..1 Selected instance UID -->
    <dicom>  <!-- 0..* Dicom web access -->
     <type value="[code]"/><!-- 1..1 WADO-RS | WADO-URI | IID | WADO-WS -->
     <url value="[uri]"/><!-- 1..1 Retrieve study URL -->
    </dicom>
    <frameNumbers value="[unsignedInt]"/><!-- 0..* Frame reference number -->
   </instance>
  </series>
 </study>
</ImagingExcerpt>

JSON Template

{doco
  "resourceType" : "ImagingExcerpt",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "uid" : "<oid>", // R!  Instance UID
  "patient" : { Reference(Patient) }, // R!  Patient of the selected objects
  "authoringTime" : "<dateTime>", // Time when the imaging object selection was created
  "author" : { Reference(Practitioner|Device|Organization|Patient|
   RelatedPerson) }, // Author (human or machine)
  "title" : { CodeableConcept }, // R!  Reason for selection
  "description" : "<string>", // Description text
  "study" : [{ // R!  Study identity of the selected instances
    "uid" : "<oid>", // R!  Study instance UID
    "imagingStudy" : { Reference(ImagingStudy) }, // Reference to ImagingStudy
    "dicom" : [{ // Dicom web access
      "type" : "<code>", // R!  WADO-RS | WADO-URI | IID | WADO-WS
      "url" : "<uri>" // R!  Retrieve study URL
    }],
    "viewable" : [{ // Viewable format
      "contentType" : "<code>", // R!  Mime type of the content, with charset etc. 
      "height" : "<positiveInt>", // Height of the image in pixels (photo/video)
      "width" : "<positiveInt>", // Width of the image in pixels (photo/video)
      "frames" : "<positiveInt>", // Number of frames if > 1 (photo)
      "duration" : "<unsignedInt>", // Length in seconds (audio / video)
      "size" : "<unsignedInt>", // Number of bytes of content (if url provided)
      "title" : "<string>", // Label to display in place of the data
      "url" : "<uri>" // R!  Uri where the data can be found
    }],
    "series" : [{ // R!  Series identity of the selected instances
      "uid" : "<oid>", // R!  Series instance UID
      "dicom" : [{ // Dicom web access
        "type" : "<code>", // R!  WADO-RS | WADO-URI | IID | WADO-WS
        "url" : "<uri>" // R!  Retrieve study URL
      }],
      "instance" : [{ // R!  The selected instance
        "sopClass" : "<oid>", // R!  SOP class UID of instance
        "uid" : "<oid>", // R!  Selected instance UID
        "dicom" : [{ // Dicom web access
          "type" : "<code>", // R!  WADO-RS | WADO-URI | IID | WADO-WS
          "url" : "<uri>" // R!  Retrieve study URL
        }],
        "frameNumbers" : ["<unsignedInt>"] // Frame reference number
      }]
    }]
  }]
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingExcerpt DomainResourceKey Object Selection
... uid Σ1..1oidInstance UID
... patient Σ1..1Reference(Patient)Patient of the selected objects
... authoringTime Σ0..1dateTimeTime when the imaging object selection was created
... author Σ0..1Reference(Practitioner | Device | Organization | Patient | RelatedPerson)Author (human or machine)
... title Σ1..1CodeableConceptReason for selection
KOStitle (Required)
... description Σ0..1stringDescription text
... study Σ1..*BackboneElementStudy identity of the selected instances
.... uid Σ1..1oidStudy instance UID
.... imagingStudy Σ0..1Reference(ImagingStudy)Reference to ImagingStudy
.... dicom 0..*BackboneElementDicom web access
..... type 1..1codeWADO-RS | WADO-URI | IID | WADO-WS
dWebType (Required)
..... url 1..1uriRetrieve study URL
.... viewable 0..*BackboneElementViewable format
..... contentType 1..1codeMime type of the content, with charset etc.
MimeType (Required)
..... height 0..1positiveIntHeight of the image in pixels (photo/video)
..... width 0..1positiveIntWidth of the image in pixels (photo/video)
..... frames 0..1positiveIntNumber of frames if > 1 (photo)
..... duration 0..1unsignedIntLength in seconds (audio / video)
..... size 0..1unsignedIntNumber of bytes of content (if url provided)
..... title 0..1stringLabel to display in place of the data
..... url 1..1uriUri where the data can be found
.... series Σ1..*BackboneElementSeries identity of the selected instances
..... uid Σ1..1oidSeries instance UID
..... dicom 0..*BackboneElementDicom web access
...... type 1..1codeWADO-RS | WADO-URI | IID | WADO-WS
dWebType (Required)
...... url 1..1uriRetrieve study URL
..... instance Σ1..*BackboneElementThe selected instance
...... sopClass Σ1..1oidSOP class UID of instance
...... uid Σ1..1oidSelected instance UID
...... dicom 0..*BackboneElementDicom web access
....... type 1..1codeWADO-RS | WADO-URI | IID | WADO-WS
dWebType (Required)
....... url 1..1uriRetrieve study URL
...... frameNumbers 0..*unsignedIntFrame reference number

doco Documentation for this format

UML Diagram

ImagingExcerpt (DomainResource)Unique identifier of the DICOM Key Object Selection (KOS) representationuid : oid [1..1]A patient resource reference which is the patient subject of all DICOM SOP Instances in this ImagingExcerptpatient : Reference [1..1] « Patient »Date and time when the selection of the referenced instances were made. It is (typically) different from the creation date of the selection resource, and from dates associated with the referenced instances (e.g. capture time of the referenced image)authoringTime : dateTime [0..1]Author of ImagingExcerpt. It can be a human author or a device which made the decision of the SOP instances selected. For example, a radiologist selected a set of imaging SOP instances to attach in a diagnostic report, and a CAD application may author a selection to describe SOP instances it used to generate a detection conclusionauthor : Reference [0..1] « Practitioner|Device|Organization|Patient| RelatedPerson »The reason for, or significance of, the selection of objects referenced in the resourcetitle : CodeableConcept [1..1] « The document title code of key object selection (Strength=Required)KOStitle! »Text description of the DICOM SOP instances selected in the ImagingExcerpt. This should be aligned with the content of the title element, and can provide further explanation of the SOP instances in the selectiondescription : string [0..1]StudyStudy instance UID of the SOP instances in the selectionuid : oid [1..1]Reference to the Imaging Study in FHIR formimagingStudy : Reference [0..1] « ImagingStudy »DicomAccess type for DICOM webtype : code [1..1] « The type of DICOM web technology available (Strength=Required)dWebType! »The source system root URL / base URL, from which all content can be retrieved using the specified DICOM protocolurl : uri [1..1]ViewableIdentifies the type of the data in the attachment and allows a method to be chosen to interpret or render the data. Includes mime type parameters such as charset where appropriatecontentType : code [1..1] « The mime type of an attachment. Any valid mime type is allowed. (Strength=Required)MimeType! »Height of the image in pixels (photo/video)height : positiveInt [0..1]Width of the image in pixels (photo/video)width : positiveInt [0..1]The number of frames in a photo. This is used with a multi-page fax, or an imaging acquisition context that takes multiple slices in a single image, or an animated gifframes : positiveInt [0..1]The duration of the recording in seconds - for audio and videoduration : unsignedInt [0..1]The number of bytes of data that make up this attachmentsize : unsignedInt [0..1]A label or set of text to display in place of the datatitle : string [0..1]A location where the data can be accessedurl : uri [1..1]SeriesSeries instance UID of the SOP instances in the selectionuid : oid [1..1]DicomAccess type for DICOM webtype : code [1..1] « The type of DICOM web technology available (Strength=Required)dWebType! »The source system root URL / base URL, from which all content can be retrieved using the specified DICOM protocolurl : uri [1..1]InstanceSOP class UID of the selected instancesopClass : oid [1..1]SOP Instance UID of the selected instanceuid : oid [1..1]The specific frame reference within a multi-frame objectframeNumbers : unsignedInt [0..*]DicomAccess type for DICOM webtype : code [1..1] « The type of DICOM web technology available (Strength=Required)dWebType! »The source system root URL / base URL, from which all content can be retrieved using the specified DICOM protocolurl : uri [1..1]Methods of accessing using DICOM web technologiesdicom[0..*]A set of viewable reference images of various typesviewable[0..*]Methods of accessing using DICOM web technologiesdicom[0..*]Methods of accessing using DICOM web technologiesdicom[0..*]Identity and locating information of the selected DICOM SOP instancesinstance[1..*]Series identity and locating information of the DICOM SOP instances in the selectionseries[1..*]Study identity and locating information of the DICOM SOP instances in the selectionstudy[1..*]

XML Template

<ImagingExcerpt xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <uid value="[oid]"/><!-- 1..1 Instance UID -->
 <patient><!-- 1..1 Reference(Patient) Patient of the selected objects --></patient>
 <authoringTime value="[dateTime]"/><!-- 0..1 Time when the imaging object selection was created -->
 <author><!-- 0..1 Reference(Practitioner|Device|Organization|Patient|
   RelatedPerson) Author (human or machine) --></author>
 <title><!-- 1..1 CodeableConcept Reason for selection --></title>
 <description value="[string]"/><!-- 0..1 Description text -->
 <study>  <!-- 1..* Study identity of the selected instances -->
  <uid value="[oid]"/><!-- 1..1 Study instance UID -->
  <imagingStudy><!-- 0..1 Reference(ImagingStudy) Reference to ImagingStudy --></imagingStudy>
  <dicom>  <!-- 0..* Dicom web access -->
   <type value="[code]"/><!-- 1..1 WADO-RS | WADO-URI | IID | WADO-WS -->
   <url value="[uri]"/><!-- 1..1 Retrieve study URL -->
  </dicom>
  <viewable>  <!-- 0..* Viewable format -->
   <contentType value="[code]"/><!-- 1..1 Mime type of the content, with charset etc.  -->
   <height value="[positiveInt]"/><!-- 0..1 Height of the image in pixels (photo/video) -->
   <width value="[positiveInt]"/><!-- 0..1 Width of the image in pixels (photo/video) -->
   <frames value="[positiveInt]"/><!-- 0..1 Number of frames if > 1 (photo) -->
   <duration value="[unsignedInt]"/><!-- 0..1 Length in seconds (audio / video) -->
   <size value="[unsignedInt]"/><!-- 0..1 Number of bytes of content (if url provided) -->
   <title value="[string]"/><!-- 0..1 Label to display in place of the data -->
   <url value="[uri]"/><!-- 1..1 Uri where the data can be found -->
  </viewable>
  <series>  <!-- 1..* Series identity of the selected instances -->
   <uid value="[oid]"/><!-- 1..1 Series instance UID -->
   <dicom>  <!-- 0..* Dicom web access -->
    <type value="[code]"/><!-- 1..1 WADO-RS | WADO-URI | IID | WADO-WS -->
    <url value="[uri]"/><!-- 1..1 Retrieve study URL -->
   </dicom>
   <instance>  <!-- 1..* The selected instance -->
    <sopClass value="[oid]"/><!-- 1..1 SOP class UID of instance -->
    <uid value="[oid]"/><!-- 1..1 Selected instance UID -->
    <dicom>  <!-- 0..* Dicom web access -->
     <type value="[code]"/><!-- 1..1 WADO-RS | WADO-URI | IID | WADO-WS -->
     <url value="[uri]"/><!-- 1..1 Retrieve study URL -->
    </dicom>
    <frameNumbers value="[unsignedInt]"/><!-- 0..* Frame reference number -->
   </instance>
  </series>
 </study>
</ImagingExcerpt>

JSON Template

{doco
  "resourceType" : "ImagingExcerpt",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "uid" : "<oid>", // R!  Instance UID
  "patient" : { Reference(Patient) }, // R!  Patient of the selected objects
  "authoringTime" : "<dateTime>", // Time when the imaging object selection was created
  "author" : { Reference(Practitioner|Device|Organization|Patient|
   RelatedPerson) }, // Author (human or machine)
  "title" : { CodeableConcept }, // R!  Reason for selection
  "description" : "<string>", // Description text
  "study" : [{ // R!  Study identity of the selected instances
    "uid" : "<oid>", // R!  Study instance UID
    "imagingStudy" : { Reference(ImagingStudy) }, // Reference to ImagingStudy
    "dicom" : [{ // Dicom web access
      "type" : "<code>", // R!  WADO-RS | WADO-URI | IID | WADO-WS
      "url" : "<uri>" // R!  Retrieve study URL
    }],
    "viewable" : [{ // Viewable format
      "contentType" : "<code>", // R!  Mime type of the content, with charset etc. 
      "height" : "<positiveInt>", // Height of the image in pixels (photo/video)
      "width" : "<positiveInt>", // Width of the image in pixels (photo/video)
      "frames" : "<positiveInt>", // Number of frames if > 1 (photo)
      "duration" : "<unsignedInt>", // Length in seconds (audio / video)
      "size" : "<unsignedInt>", // Number of bytes of content (if url provided)
      "title" : "<string>", // Label to display in place of the data
      "url" : "<uri>" // R!  Uri where the data can be found
    }],
    "series" : [{ // R!  Series identity of the selected instances
      "uid" : "<oid>", // R!  Series instance UID
      "dicom" : [{ // Dicom web access
        "type" : "<code>", // R!  WADO-RS | WADO-URI | IID | WADO-WS
        "url" : "<uri>" // R!  Retrieve study URL
      }],
      "instance" : [{ // R!  The selected instance
        "sopClass" : "<oid>", // R!  SOP class UID of instance
        "uid" : "<oid>", // R!  Selected instance UID
        "dicom" : [{ // Dicom web access
          "type" : "<code>", // R!  WADO-RS | WADO-URI | IID | WADO-WS
          "url" : "<uri>" // R!  Retrieve study URL
        }],
        "frameNumbers" : ["<unsignedInt>"] // Frame reference number
      }]
    }]
  }]
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

4.36.4.1 Terminology Bindings

PathDefinitionTypeReference
ImagingExcerpt.title The document title code of key object selectionRequiredKOStitle
ImagingExcerpt.study.dicom.type
ImagingExcerpt.study.series.dicom.type
ImagingExcerpt.study.series.instance.dicom.type 		The type of DICOM web technology availableRequireddWebType
ImagingExcerpt.study.viewable.contentType The mime type of an attachment. Any valid mime type is allowed.RequiredBCP 13 (RFCs 2045, 2046, 2047, 4288, 4289 and 2049)

4.36.4.2 Use Case

4.36.4.2.1 EHR access to imaging studies

Amy, a family physician, is accessing a cross-enterprise document registry that contains radiology objects (IHE Radiology XDS-I ), to discover studies for her patient, Alex. Her EHR client makes a FHIR call for all ImagingObjectSelection objects available for Alex. In the response, she is able to get study identifiers for each study that has been published to the registry. There is enough information provided in the response to obtain a thumbnail via a WADO-RS call, or to launch a viewer using an IHE Radiology - Invoke Image Display (IID) profile call using the url elements found in the ImagingObjectSelection. In each result, there is a reference to the ImagingStudy FHIR object which can provide more information about each study.

4.36.4.2.2 Comprehensive Imaging Scheduled Workflow

Joe Angina complains of shortness of breath and occasional chest pain to his primary care physician, Dr. Pat Down at Local MultiClinic, who orders a stress echocardiogram; the order is created as a FHIR Order resource to manage the workflow, with a link to a DiagnosticOrder resource with the details of the request. The order is scheduled and assigned to cardiologist Dr. Art Skann, also at Local MultiClinic.

On the scheduled day of the exam, Joe arrives at the echo lab to meet with Dr. Skann and have the study done. Dr. Skann’s workstation shows the daily list of Order, and he follows the link to retrieve the DiagnosticOrder. (He may follow the links through the referenced Patient resource to access Joe’s electronic medical record, but that is not the concern of this storyboard.)

The Order and DiagnosticOrder has been transcoded to a DICOM Modality Worklist Scheduled Procedure Step, and in the echo lab the equipment has downloaded the Modality Worklist. The study is performed, and the acquired images and sonographer’s preliminary measurements are stored in the Local MultiClinic Picture Archiving and Communication System (PACS). The PACS creates an ImagingStudy resource for each study it manages.

Dr. Skann interprets the study on a PACS workstation, and he selects two key image frames to be included in the diagnostic report; this selection is stored back to the PACS as a DICOM Key Object Selection with the title "For Report Attachment", and the PACS makes it available (transcodes it) as a FHIR ImagingObjectSelection resource. Dr. Skann dictates the report using a structured data entry report writing program, including a recommendation for a cardiac catheterization procedure, and signs it. The report writing program formats the report as a CDA document, retrieves the ImagingObjectSelection resource, and inserts the referenced key images into the report.

Dr. Down meets again with Joe, and they review the results of the stress test. Joe has a question about the findings that the key images in the report do not show, so Dr. Down uses the Local MultiClinic EMR to query the PACS for the full ImagingStudy resource, and uses the references there to open an image display for the full study. Joe agrees to proceed to catheterization, and Dr. Down sends a referral to the Ginormous University Hospital cath department, and triggers the PACS to share the echo study through the Metropolitan Health Information Exchange.

The PACS creates a manifest of the study as an ImagingObjectSelection resource, which includes all the images but excludes the sonographer’s preliminary measurements (which as a matter of policy are not shared outside the Local MultiClinic). The manifest is published to the Metro HIE. (In accordance with IHE XDS-I , the images themselves are not directly published to the HIE, but available for on-demand retrieval from the PACS.)

At Ginormous Hospital, Dr. Cora Plummer receives the cath referral, and looks up the study in the Metro HIE registry. She retrieves the study manifest ImagingObjectSelection, and uses it to access the shared images, which she uses to prepare for the cath procedure.

4.36.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
authorreferenceAuthor of key DICOM object selectionImagingExcerpt.author
(Device, Patient, Organization, Practitioner, RelatedPerson)
authoring-timedateTime of key DICOM object selection authoringImagingExcerpt.authoringTime
identifieruriUID of key DICOM object selectionImagingExcerpt.uid
patientreferenceSubject of key DICOM object selectionImagingExcerpt.patient
(Patient)
selected-studyuriStudy selected in key DICOM object selectionImagingExcerpt.study.uid
titletokenTitle of key DICOM object selectionImagingExcerpt.title